Friday, May 20, 2011

Sorry I refused to work you in yesterday afternoon. I had an open slot, and would much rather see you here, and get paid for it, then have an empty hour.

But when you called Mary and said you'd had a horrible headache all morning, and couldn't move your right arm very well, she quickly became alarmed that this wasn't something that should be handled in my office. In fact, she told you to call 911, and you refused, saying you'd rather just drive over to see me.

That personally alarmed me, because obviously you shouldn't be driving in your condition. When Mary told me that I decided to get on the phone myself.

Your speech was a bit slurred, and I again reiterated that you should call 911. I even offered to call them for you, and asked for your address or phone number, so I could get them to your house. You refused, on the grounds that your co-pay for an ER visit was higher than it was to come to my office.

Then you told me that you didn't want to see me anyway, because obviously I didn't care about someone who needed help. And you hung up.

35 comments:

It's amazing the things people will do to save a buck, even at their own expense. If a medical professional told me I should go to an ER over seeing them, I'm inclined to go to an ER for whatever's ailing me!

It kind of freaks me out that you can't know if her idea of "saving a buck" was a symptom of her apparant stroke or not. I once saw some confusion only related to a water cup during a stroke. The man seemed mentally fine otherwise, but he was mad as hell that the water cup would not speak to him and answer his questions. Neuro is sooo wierd.

Many health plans waive the ER co-pay if the patient is admitted. Her head was certainly not in the right place, I hope she got help. That would make me ill, had I experienced it firsthand. I wanted to scream on your behalf upon reading this.

"Why would I go to the ER? Are you sure that I shouldn't drive an hour into your office to try and see the doctor while my airway is closing and I'm having trouble breathing? *wheeze-gasp-wheeze* If I drive really fast, I'll probably make it before I pass out."

We can be all smarmy on this side of the pond and say it wouldn't happen here but sometimes the patients want to see me for "reassurance" first rather than attend A&E. If I tell them to go straight to A&E I am somehow portrayed as passing the buck.Anyway, give it a few years and the English NHS will have gone the same way (though we may get a reprieve in Wales).

Once when i worked at a GYN a woman OBVIOUSLY in labor called and asked what to do. We told her to goto the hospital. Her response was that she didn't have permission from her husband to leave the house (strict muslim household) and that she was scared adn alone. Again we asked her to call 911. She said she couldn't without her husband's permission. It was a terrible call.. I completely know what you went thru.. and mine wasn't even a likely stroke. I hope she is seeking care today.

We get those guys in the pharmacy too. They come up to the counter with serious symptoms and ask what kind of OTC thing I can recommend. There have been a few times I've called 911 for them myself, but most of the time they refuse, so I'm left with "see your PCP as soon as possible."

My favorite, though he probably wasn't as serious as some of the others, was a guy who lacerated himself with a weedwhacker to the point he was loosing so much blood he was dizzy. As he stood at the counter, asking what I would do about the wound, I could see the bandage he had put on seeping with blood and drops all over the floor. Clearly, something your pharmacist could help you with.

same with amandagal, i have had many arguments w/ patients at the pharmacy counter as i urge them to see a doctor and they try to get me to recommend something OTC.

one time, i have a guy who had a spider bite on his leg and the leg is starting to feel numb. i told him to go to the hospital immediately (we live in black widow country), but he still insist on using benadryl and going home to sleep it out...

My healthcare plan allows youto waive the co-pay in this situation and the hospital would allow you to be billed. I get complex/complicated migraines and get these symptoms a few times. I have been told if I don't go (against their advice or ignore thesymptoms) I could say adios to coverage. I don't think it is a faulty heathcare system, just a faulty patient.

Tough day Doc, there is no shortage of people who want to dump their problems onto the most convenient lap and divorce themselves from any sense of responsibility for themselve. Most folks get over that sickness by the end of their teen years.

This is completely unrelated... I stumbled across your blog after someone linked to you somewhere else. LOVE IT! I'm not in the medical field, but I remain highly amused by your stories. Thanks so much for sharing. We dealt with neurologists for years (most of whom could have been named Dr. Pissy) and you are a breath of fresh air.

Can't tell you how many times this happens in my cardiology practice! An office setting is NOT THE PLACE for someone with severe symptoms. Patients just don't realize that we don't have the tools/ability to do testing in the office that they clearly need (ex. stat labs, xrays, etc.) and if they come in they will likely be sent to the ER anyway. It's obvious that you cared and kudos to Mary for recognizing that she needed to go to the ER.

Wow, that's a sad phone call! It must be really frusterating to have had to deal with that and now have no idea if the woman is even okay. I can honestly say that I can't understand her train of thought. I mean, I understand the money issue but if a neurologist was concerned enough to send me to a hospital, I'd go! Sometimes you have to take care of the problem and worry about the details later. Hope the lady got some help in time! It certainly sounds like you did everything you could do for her.

actually, it ia bad feature of health care that unless you have a genius family member by your side 24 hrs a day, you have to make tough decisions by yourself when you are sick, in pain, impaired...add to that that hospitals frighten a lot of people and they just do not want to go. My current insurance plan has a 24 hr "phone-a-nurse-for-advice" which I think might help people make a good decision, but I have never used the service.

what a blooming idiot! i was having a full blown asthma attack and called my doctors office and was told to go to ER. did. their office called ahead and i didn't wait at all. it pays to call the doctor and let them know.i think she deserves another doctor, not one that cared enough to talk to me on the phone.

Give them *YOUR* phone number and the time of the call. It also may help not to answer any more incoming calls for a few minutes, too. (Not that that should be a problem while you're on the phone with 911.)

They can usually get the phone company to check their billing records fairly quickly. (All calls, even local calls that won't actually be charged, produce a billing record. They can identify the last number to call you, or a specific call given the date/time.)

It can take them 15 minutes to an hour, but I suppose it's better than nothing.

You might consider adding a "quick script" response to statements like that (won't go to ED/call 911) with the reply that "OK - I just need your address and phone number to create a medical record/ patient account." And as soon as the person gives enough info to track, put 'em on hold and dial 911. Then just keep them on the line until first responders are there. Deception I think is OK ethically when the patient is in apparent imminent danger and initiated the request for help

Two: what she said is pretty clearly indicative of executive dysfunction - a cognitive deficit. I sure wouldn't take it personally or as an insult. Her logic is faulty. Could be Alzheimers, another neurodegen. issue or an acute issue.

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This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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